Friday, January 27, 2017

The Mylan EpiPen debacle may have inadvertently
weakened the grip Big Pharma on U.S. lawmakers.Last week, a bill proposed by Senator Bernie Sanders was narrowly rejected
by a vote of 52-46.Unexpectedly, 12
Republicans and 1 Independent voted with Senator Sanders in favor of allowing
pharmacists and distributors to import cheaper prescription drugs from Canada
and other foreign countries (something typically favored by Democrats.)The winds of change are starting to blow in
the bipartisan direction when it comes to the pharmaceutical industry.

U.S. Healthcare
needs a revolution ; ‘the shot heard round the world’ frequently refers to
the opening shots of the American Revolution in 1775.The Big Pharma lobby is holding the
American people hostage with their exorbitant ransom demands.Last summer, Mylan
Pharmaceuticals, led by CEO Heather Bresch, overplayed their hand.Mylan came under fire for a 400% price
increase in the EpiPen two-pack.This device
is considered life-saving for children and adults with anaphylactic reactions
to various food, insect, or environmental insults.Ms. Bresch insisted the significant price increase
($600-$700 for a medication which costs pennies) was justified due to the more
ergonomic appearance of the delivery device and improved safety profile.“There was a lack
of access to appreciating the role epinephrine
plays in the role of severe reaction.”Classic Big Pharma:when
encountering difficulty with access, by all means, hike the price of your
device.Her miscalculation seems to have
indirectly incited the war on Big Pharma by angering the public, the media, and
the government simultaneously.

Ms. Bresch landed
herself in front of the House Oversight and Government Reform Committee on
September 21st, in attempts to defend her bold decision, where she
insisted the company only
profited $100 on each two-pack.Somehow despite a paltry profit margin, her
salary ballooned
from 2.5 million to almost 19 million between 2007 and 2015.Later that same
month, the Centers for Medicare and Medicaid Services (CMS) discovered the
EpiPen had been misclassified as a generic drug, making it ineligible for the low
rebates Mylan was paying back to Medicaid.Essentially, Mylan overbilled Medicaid for its life-saving drug resulting
in being saddled with a large settlement.

In December 2016, Ms. Bresch took full
responsibility for marking up the price of EpiPen.Her reasoning was “we realized there’s an
underserved patient population” and “a lack of awareness of severe allergic
reactions and how to treat them from physicians and parents.”Seriously?Not only is she lying about primary care physicians not understanding
anaphylaxis,; she is trying to convince us that those who are underserved are
helped by paying $600 for Mylans’ life-saving device.She is using dishonesty to support bilking
millions out of consumers.

Ironically, CEO Heather Bresch
is the daughter of U.S. Senator Joe Manchin (D-W.V.). Bresch has had ethical
difficulties throughout her illustrious career starting
when her father was a governor.Every
decision she makes seems to border on unscrupulous.Laws in at least 11 states require
schools to stock epinephrine, and keeping a stockpile is incentivized by
federal law. So Mylan started the EpiPen4Schools program, in 2012, which provided free
EpiPen two-packs to more than 65,000 schools, in an effort to ‘help’ children
access life-saving medication.The
EpiPen4Schools discounted price was $112.10; however, in order to qualify for
that price, schools
had to agree they would not purchase products from any EpiPen competitors during
the next twelve months.A Mylan
spokesperson said this requirement is no longer part of its program as of
July1, 2016.

As Inauguration Day came to a close, I found myself
reflecting on the positives and negatives of the most recent Presidential
campaign; it appears one noble outcome may be the ushering in of true
bipartisanship to Washington.Big Pharma
has relied upon their strategic lobbying efforts and targeted donations to key
political insiders to ensure someone in power was always looking after their
interests.It appears the direct
tactical approach by Trump could redefine those battle lines.His comments calling out the pharmaceutical
industry on their predatory tactics, sent drug sector stocks into a tailspin.

The morning of the pharmaceutical bill vote, President-elect
Donald Trump accused Big Pharma of “getting away with murder.”He pointed out “there’s very little bidding
on drugs,” blaming the harmful influence of the pharmaceutical lobby.Currently, federal law prohibits our government
from negotiating Medicare drug prices with the pharmaceutical companies.Trump has called for dissolving this policy
in the past, another virtue that tends to be favored by Democratic
lawmakers.Federal laws regulate much of
healthcare delivery; why not Big Pharma? The tide may be turning; four more
votes are all that are needed next time.Rep. Peter Welch (D-Vt.) has introduced a bill that would allow Medicare
negotiation on drug prices.Prohibiting
Medicare from the first right of refusal in regard to price negotiation and
medication formulary exclusion absolutely must end.

The Pharmaceutical Research and Manufacturers
of America (PhRMA), oppose Medicare negotiation and importation of foreign
medications because they “will not ensure prescription drugs entering the U.S.
from abroad are safe and effective.”Who
are they kidding?Have you purchased
medications outside the country before?It
is a veritable smorgasbord of brand name medications, all with labels printed
in English.It’s almost as if the
medications walked across the border on their own accord.Big Pharma keeps peddling fear and
trepidation; however, the tight grip they have had over Washington is indeed
loosening.

Those who supported Senator Sanders’ bill
should be commended for voting with their conscience instead of their
pocketbooks.The 13 courageous GOP and
Independent Senators who voted with Sen. Bernie Sanders are: John Boozman (AR),
Susan Collins (ME), Ted Cruz (TX), Jeff Flake (AZ), Charles Grassley (IA), Dean
Heller (NV), John Kennedy (LA), Curtis King (ME), Mike Lee (UT), John McCain
(AZ), Lisa Murkowski (AK), Rand Paul (KY), and John Thune (SD.) It is
worthwhile to note, 13 Democratic Senators voted against this bill, however
many, including my own Senator from Washington State, Patty Murray, had ties to
the pharmaceutical industry.She
received 300K in funding from Big Pharma during her most recent re-election
bid.

The overconfidence of Mylan Pharmaceuticals in
support of government and the public for restricting access to life-saving
medications for children was “the shot heard round the world.”In
one sweeping move, their CEO violated the trust of the consumer, by bankrupting
them, Wall Street, as evidenced by declining share price, the pharmaceutical
industry, by exposing their profit-driven manifesto, and most importantly, the federal
government and its lawmakers.

Recently, CVS announced it would begin
stocking a competitor of EpiPen, Adrenaclick,
for $110, a textbook example of free market
forces at work.An epinephrine delivery
device has become available for $10 to patients at the largest pharmacy
retailer in the nation within 6 months of Mylans’ price misstep.Most individuals with private insurance now qualify
for a manufacturer’s coupon knocking $100 off the price which will be applied
right at the register.The public
maelstrom started by the CEO of Mylan not only took a toll on their share price,
which tumbled from $54 to $36, but lost the monopoly on schools, pharmacies,
and patients at the same time.

When President Ronald Reagan gave his infamous
speech “Tear down this wall”, he noticed words of wisdom spray painted upon its structure; ‘This
wall will fall. For it cannot withstand faith; it cannot withstand truth. The
wall cannot withstand freedom’.Walls of Big Pharma have begun to crumble and it is
time to hold their feet to the fire.Four more votes stand between consumers and the freedom to purchase
medications in foreign countries for pennies on the dollar.Mylan deserves credit for showing us the
‘true colors’ of the pharmaceutical industry and my sincere hope is they can no
longer stand in the way of the acquisition of knowledge, truth, and freedom of
individuals to manage health for themselves.

Thursday, January 26, 2017

This is a call to action for all 860,000 physicians in the United States of America. Can
you remember a time when practicing physicians played a vital role in
healthcare reform? No, because it’s never happened. We are a
crucial piece of the puzzle, and our expertise is needed to find a
way to deliver quality, affordable healthcare to the citizens of our
great nation. Our current system is on the verge of collapse. If we
cannot get the attention of our legislators, we have no way to save
it.

The voices of practicing physicians on the front lines of
medicine have been silenced for too long.

We cannot afford to wait for others to confer power,
voice, or authority upon us. History shows that authority is claimed,
not conferred, and we must claim authority over our own field before
pharmaceutical and insurance companies wrest it away from us.
Practicing physicians must have a seat at the healthcare reform
table.

The
Practicing Physicians of America (PPA) will be hosting a town hall
meeting at the Library of Congress in the Jefferson Room on February
2, 2017 at 8:30am. PPA is a consortium of grassroots physician-led
groups that have been collaborating on the issue of patient-centric
healthcare reform for years. This is a unique and historic moment
for us to come together as physicians and speak on behalf of our
profession and our patients.

We
invite lawmakers, health policy experts, and representatives of the
administration to join us for six brief presentations, followed by
panel discussion with lawmaker participation. Presentation topics
include: MOC reform, quality reporting pitfalls, reforming the mental
health system, responsible public health, improving patient care by
helping the healers, and the impact of social media on the current
landscape.

Given
the short notice, we welcome lawmakers to stop in at the event or
contact us if interested in our stopping by their office for a short
meeting. This can include photo opportunities for us to promote
National Womens' Physicians Day, February 3, 2017.

Physicians
must stand up and be counted. Our time is now. Practicing physicians
can deliver valuable insight and novel perspective on how to enact
change. We must give the power to make healthcare
decisions back to the patient and their doctor, rather than to the
insurance and pharmaceutical industries.

The
historical perspective of healthcare reform has never included the
one occupation at its core: practicing physicians. We must organize,
speak up, and take action. It is time to shine a light on the healers
of America who want to heal our broken healthcare system. Contact
your representative today and invite them to join Practicing
Physicians of America at the Library of Congress on February 2, 2017.
All questions and responses are directed to
one of our fearless leaders, Marion Mass, MD at marion@practicingphysicians.org.
#healthcare #MOCreform #ACA #PPA

Tuesday, January 24, 2017

The Centers for Medicare & Medicaid
Services (CMS) EHR Incentive Program—also known as Meaningful Use (MU)—initially
provided incentives to accelerate the adoption of electronic health records
(EHRs) to meet certified program requirements.Many physicians were mandated to change over
to electronic records at the cost of tens of thousands of dollars.Electronic records have never been shown to
improve patient care or outcomes with statistical significance, the criteria
physicians routinely use when making care decisions.

Physicians who failed to participate in MU would
receive penalties in the form of reduced Medicare reimbursements automatically.
To avoid a penalty, physicians had to implement certified electronic health
records (CEHRT) and demonstrate MU of that technology through an attestation
process at the end of each reporting period.There were 10 data specifications. Approximately 209,000 physicians were facing
penalties at the start of 2016, almost one-fourth of the U.S. physician
workforce.

By the end of 2015, CMS had stated it would
broadly accept applications for hardship exemptions because of the delayed
publication of the program regulations. Applications
for physicians were due by July 1, 2016.

A friend of mine opened a private practice in
October 2015 and thought she was on the right path toward submitting data and meeting
MU requirements.One of the most challenging
things about running a business is hiring excellent ancillary staff for support.Employees should be smart, capable, and well,
able to reliably submit data.It is
worthwhile to note physicians receive no business training in medical school,
so the learning curve is steep for all physicians including my friend, who is a
family practice doctor.

There are mistakes and triumph along the way
and my friends’ misstep was hiring an office manager who ultimately was not a
good fit – unbeknownst to the physician, she did not submit ANY data.The notification arrived in the mail that
this practice did not meet all 10 MU program requirements. “We had recently
acquired a new EHR (cost 6K) and were uncertain how to verify data had been
submitted.We were working on it.” She
contacted CMS and they denied any opportunity for appeal.

Welcome to the penalty box, with no term
limit. Every single visit, procedure, counseling session, or medical
intervention will have 2% shaved off the top.The average family
physician receives about $100,000 a year in Medicare reimbursements, so a 2%
penalty for 2017 will become3% in 2018,
and increase to 4% in 2019—a combined three-year total of $9,000.

This total overlooks the increased costs and overhead
of running a business. Staff members get raises; medical supplies cost more,
and even medical license fees continue increasing --- all while the physicians’
income is decreasing with no end in sight.

This young physician is working in her hometown
somewhere in Middle America, a small community, with a population of
13,000.She is there because her family
and friends are nearby.She loves her
patients; 50% of them are insured by Medicare and Medicaid.She provides high quality care; for which she
will be paid less and less each year.

This physician is neither lazy nor
stupid.She is just not a businesswoman,
yet.She opened her practice straight
out of residency and was under the impression she did not need to submit data immediately
while getting things settled.Once she began
“submitting” data, she trusted the office manager to do it, because she was
otherwise engrossed in seeing patients, (a part of our profession likely to disappear
in the near future.)The art of
practicing medicine will become an outdated and ridiculous notion at the rate
we are going.

My advice for every primary care physician in
this country is to opt-out of Medicare and Medicaid so our businesses can
survive.This particular physician
cannot do that as the hospital has guaranteed her salary for one year while she
gets her practice started.What a great
deal for the hospital! The primary care physician is left to their own devices,
to build a practice, and serve as a source of revenue feeding the specialists,
who are employed by the hospital in this particular scenario.The hospital did offer to employ her; however
the wage was far below the industry standard.

This family physician might reluctantly have
to close her Medicaid and Medicare panels anyway. If her business begins
failing due to the penalties being leveraged, she will opt out of both Medicare
and Medicaid.So will us all if this
punitive payment structure continues unabated.

This scenario is repeating itself over and
over across the country every day.Private practice physicians are stuck between a rock and hard
place.Indentured servitude is on one
side and the freedom to independently practice medicine is on the other.

Financial analyst John Graham at Forbeswrote in April
of 2015 that MACRA was a “fiscally irresponsible approach to increasing the
amount the federal government spends on Medicare’s physicians’ services.”What should we do when working with a
fiscally irresponsible person?Do we
jump on board and begin a business partnership?No.Then why are physicians acquiescing
to this abuse?MACRA penalties will
begin in 2019 at 4% and increase to 9% by 2022.Who can afford to stay in practice at the rate of decline in
reimbursement?

In general, physicians tend to be
compassionate and empathetic, they are rule followers, and do the ‘right’
thing; traveling on the straight and narrow should not bring us to the point where
we cannot make more than we would working in a fast food restaurant.The answer is we must opt-out until changes
are made.Private practice physicians need
to realize we are on our own.The AMA,
ACP, and CMS are working in direct opposition to independent physicians fighting
hard to break the chains that bind us.It is simply time to let go and walk away.

Suneel Dhand recently wrote, “it’s not just the ace of spades that
the doctor and patient are holding — but the entire deck.”He is right.It is time for us to become dealers.And I want to play dealers’ choice.

Tuesday, January 17, 2017

Thirteen years ago, I received a call from the mother of a college freshman
who was concerned because her son had been diagnosed with mononucleosis during
finals week.She felt something was not quite
right and asked me for advice.“Trust
your instinct, go get him, and bring him home.” She brought him to my clinic
the following day.He looked mildly ill.His vitals were stable; he was fatigued, slightly
dehydrated, and pale.His tonsils were enlarged
to the point they were “kissing,” though not causing airway obstruction.I gave him a steroid injection, with strict
orders to go home, rest, drink clear liquids, and return with his mother the next
morning.

On the second day, he walked in looking unequivocally worse.He was complaining of neck pain, though not
stiffness, and his tonsils were considerably more swollen.I drew blood, sent it off, and recommended a lateral
neck film to evaluate his airway.The lab
called within the hour for an unusual finding.He had atypical lymphocytes (mono cells) and a few schistocytes (chewed
up cells) on his smear, he had thrombocytopenia (low platelets), and his sedimentation
rate (a marker of inflammation) was unexpectedly low, something I had not encountered
before.I pulled out the book to search
for causes of low ESR and a particular one jumped out.The test can be a marker for fibrinogen
levels, which if abnormal, may indicate disseminated intravascular coagulation
(DIC), a serious complication of infection.I spoke with the lab and added a PT, PTT, fibrinogen and D-dimer levels
(tests to help with diagnosis.)

The radiologist called to say my patients’ airway was narrowed and as I was
contemplating my next step, he and his mother returned.I will never forget the look of fear in his
mothers’ eyes as he assumed a “tripod” position with labored breathing in my
waiting room.I am certain distress was
etched on my face as well.I called an
ambulance to take him to the nearest hospital.His mother started sobbing and I held her hand while we waited for EMS
to arrive.I promised her he was going
to be alright, not being certain whether or not that was the truth. Once on his
way in the ambulance, I breathed a sigh of relief.

The term glandular fever was first used in 1889 by German physicians who
recognized a clinical syndrome with the classic triad of fever, pharyngitis,
and lymphadenopathy. “The kissing disease” is transmitted via primarily oropharyngeal
secretions. 50% of children are infected before age 5; approximately 12% of
susceptible college-aged young adults seroconvert each year, some of whom
experience severe complications.

Patients with infectious mononucleosis present clinically with fatigue,
which may be profound, but usually resolves over 3 months. Nausea, without vomiting,
weight loss, and anorexia are common.Mortality
and morbidity due to uncomplicated EBV infectious mononucleosis infections are
low. There is really no treatment for this condition except rest, hydration,
and the tincture of time.However, massive
tonsillar enlargement may result in airway obstruction, for which steroids are
indicated, which was present in this particular case. Rarely, mononucleosis results in more severe
complications, such as encephalitis, pancreatitis, myocarditis, and
myositis.

While I see mononucleosis often, I have not seen a case of DIC in the last 13
years.He was admitted to the ICU that
evening and remained there for 3 days on steroids and antibiotics.D-dimers came back positive and the rest of
his labs were consistent with DIC. He decided to take some time off from school
to recover and was able to make up the finals he missed during the next
semester. Over the years, he moved on to
his adult life elsewhere and we lost touch.

About twice a year, patients from the past stop by for a ‘social call’ while
passing through town. ‘Visitors’ are always
an unexpected blessing to my day. I remember
every single one by name, even after almost two decades in practice.This visitor was the young man’s brother, who
is just as special to me.I hugged him
and he handed me an envelope from his mother.His older brother turned 31 recently and is doing well.I opened the card to find these handwritten
words:

“Not a year goes by without conversations about you, and
much gratitude for truly saving my son’s life when he had mononucleosis in
2003.We have had our challenges, but
all in all doing very well.”

“Every year at the beginning of December, we give extra
thanks for you, your heart, your caring, and expertise.Your efforts on our son’s behalf continue to
be perhaps the greatest blessing we
have experienced.We hope it has been
returned to you ten-fold! With much love…”

I often wonder who has been the greatest blessing to whom. A physician bears witness to the direct impact
we have on the lives of other human beings.What a rare treasure to behold!As
physicians, our journey is riddled with successes and failures.Yet, my love and dedication to this noble and
rewarding profession is instantaneously revitalized when a young person wanders
into my office and reminds me of a time when we overcame such insurmountable
odds together.

Wednesday, January 11, 2017

Robert Kennedy, Jr.is
an activist, author, and attorney specializing in environmental
law. He is the son of Robert
"Bobby" Kennedy,
a former U.S. Attorney General, and the nephew of former U.S. President John F. Kennedy.Kennedy is
President of the Board of Waterkeeper Alliance, a non-profit focused on protecting and enhancing
waterways worldwide. He has written a
book about the damaging effects of vaccinations due to thimerosol, and to round
out his extensive medical resume, he has written two children's books.By all means, with this
broad background, it is crystal clear why President-Elect Trump tapped him to
head up the Vaccine Safety Commission.

“They get the shot, that night they have a fever of
a hundred and three … and three months later their brain is gone,” Kennedy said
in 2015. His comment, “This [giving
vaccinations] is a holocaust,” is terribly offensive.He later apologized, saying, “I employed the
term during an impromptu speech as I struggled to… convey the catastrophic
tragedy of autism.” At least he has passion!I look forward to more ‘impromptu’ statements because it will definitely
keep D.C. hopping.

The bottom line is the POTUS and his appointees have
NO place in healthcare decision-making.They are not physicians; they do not have the decade plus of necessary education
and training.The government machine
lacks the basic knowledge and skills to make healthcare better on their own,
otherwise they would have accomplished it by now.It is like asking an archaeologist for stock
market investment advice.Ideally,
healthcare decisions should be between a patient and a physician.Physicians and patients need to be in
control. After today’s surprising yet possibly
fortuitous event, we could be well on our way to advancing our physician-patient-centric
agenda.

Adding to the vaccination debate, Dr. Daniel Neides,
MD, medical director and chief operating officer of the Cleveland Clinic
Wellness Institute, ignited a firestorm when he published a blog post
spewing anti-vaccine rhetoric.Dr.
Neides describes a “difficult” recovery after receiving an influenza
immunization to add insult to injury.I
lost a healthy 12 year old girl
to Influenza A last flu season, so I find his non-scientific propaganda rather offensive.Most
of us would agree the potential “damage” from vaccination is far more desirable
than the death of a child.

How far should a medical director of a large
scientific institution be allowed to veer off the path of mainstream medical
science?A medical doctor employed at a
large, prestigious medical institution has an obligation to his patients, his
colleagues, and the general public at large.At the very least,
Dr. Neidesrepresents the
Cleveland Wellness Institute and should adhere to their evidence-based
standards.For him to continue spreading
falsehoods about vaccinations, toxins, preservatives, and additional nonsense
in the future would be appalling.He
should categorically be relieved of his position as medical director.

These misrepresentations endorsed by both gentlemen
can be easily countered using scientific evidence.Research has absolutely refuted any link
between vaccinations and autism.While
immunization effectiveness leaves some room to be desired, vaccinations remain one
of the pinnacle achievements of 19th, 20th and 21st
century medicine.Devastating diseases,
such as Measles, Whooping Cough, Diphtheria, and Polio have almost disappeared.The
WHO certified the global eradication of smallpox, a virus with a mortality rate over 30%, in
1979 following
extensive vaccination campaigns
throughout the 19th and 20th century.

Genetic factors are
the most likely cause for autism spectrum disorders. Twin studies have
estimated the genetic heritability of autism to be as high as 60-90%.In most cases, there is no family history of
autism, so these de novo mutations probably occur spontaneously, leading many
to search for external causes.A crucial
distinction in all scientific medical literature is the difference between correlation and causation.Autism
is not caused by vaccinations any
more than it is by our water system (an area in which Mr. Kennedy should be
familiar.)The diagnosis of autism is correlated with many things:over-supplementation with folic acid in pregnancy,
advanced paternal and maternal age, contracting influenza during pregnancy, having
back to back pregnancies, and low birth weight infants or a history of jaundice,
however still may not be caused by
any of these.

Vaccinations save lives.In
1958, there were 763,000 cases of measles in the United States; after the
introduction of the vaccine, the number of cases dropped to fewer than 150 per
year.These are indisputable scientific facts.Anti-vaccine propaganda
has led to reduced immunization compliance and occasional disease outbreaks,
such as the Measles outbreak at Disneyland
and the current multi-state Mumps outbreak,
encompassing more than 8 states.

Neither of these two individuals has demonstrated
they have the educational background nor the expertise to diagnose autism,
weigh in on vaccine safety, or be in charge of healthcare decision making. It
is alarming to watch them promote anti-vaccine agendas while attaining prominent
positions in the mainstream healthcare system.The silver lining might be that those of us interested in truth,
science, and the sanctity of the physician-patient relationship are now on
higher moral ground with quacks at the helm.The brightest future for physicians involves being in charge of our
practices, our patients’ health, and our lives.The more non-scientific rubbish produced by influential “leaders” of
medical institutions and government agencies, the closer physicians are to
achieving those goals.

Wednesday, January 4, 2017

Mumps is a contagious disease caused
by a virus. It starts with a few days of fever, headache, muscle aches,
tiredness, and loss of appetite, which can be followed by swollen cheeks (salivary
glands) or swollen testicles in teenage boys and men. You can help protect
yourself and your family against mumps with vaccination.The mumps vaccine is pretty effective; in
general, one does of MMR prevents infection by 78%, and two doses up to 88%.

Mumps is no longer very common in the
United States, but sporadic outbreaks continue to occur, especially in places
where people have had prolonged, close contact with a person who has
mumps.Before the U.S. mumps vaccination program
started in 1967, about 186,000 cases were reported each year.Since the pre-vaccine era, there has been a 99%
decrease in mumps cases in the United States.In 2012, there were 229 cases reported in the U.S.

We
are kind of having an exciting year in regards to Mumps outbreaks; as of the
end of December 2016, seven states have reported more than 100 cases: AR, IA,
IN, IL, MA, NY, and OK.Washington is
about to join that list with approximately 30 confirmed cases in King County
and over 70 that are probable cases.Symptoms
typically appear 16-18 days after infection, but there is a long incubation
period ranging from 12-25 days after infection.Most people with mumps recover completely in a few weeks.

Mumps
can occasionally cause complications, especially in adults.Complications include:inflammation of the testicles (orchitis) in
males who have reached puberty, inflammation of the brain (encephalitis) or
covering of the brain (meningitis), and inflammation of the ovaries (less
obvious than the men.)

Here
is where it gets interesting:the
outbreak in Arkansas, Texas, and Washington State are predominately in
Marshallese people, those individuals with heritage from the Marshall
Islands.If geography is not your
favorite subject, this is a group of Islands in the Pacific Ocean.66% of those infected in Arkansas are
Marshallese.83% of those infected in
Washington State are Marshallese or have close connections with the Marshallese
community.Those with Mumps in
Washington State are mostly school aged (5-18 years) and about 90% of that
group is fully immunized.

So
what does this mean exactly?Most likely
the mumps portion of the MMR vaccine is less effective in the Marshallese
population in particular due to some genetic difference in their immune response.It is also possible this virus is “drifting” by
changing a protein here or there or an H or N molecule as similar to the
influenza virus.So all in all, there
are likely small changes in the natural mumps virus altering the landscape for everyone;
however those with Marshallese background are naturally more susceptible.

In
closing, as you would expect, I still recommend and support vaccination for all
with MMR, personally and professionally.However, no vaccination is perfect and works 100% of the time.I wanted to share some scientific information
with you all about what is happening here in the Northwest right now, most of
which was provided by the Washington State Department of Health.